Pulmonary Flashcards
When does clubbing happen
malignancy, abscess, CF and fibrosis, it does NOT happen in COPD and prompts for need to search for malignancy
MCC of digital clubbing
CF, malignancy, RL shunts in heart (megakarycytes shunted past pulm circulation)
S/s of CHF versus COPD exas?
CHF will have bilateral crackles in the lower bases along with a dry cough and no production of sputum
How do ABG in CHF compared to COPD
In CHF they have hypoxia, increased RR and alkalosis and hypocapnia as opposed to CHF with hypoxia, and hypercarbia due to CO2 retention and often a mild acidosis
COPD exac ABG
Acidosis, hypoxia, hypercarbia
Big thing that tells you something is COPD versus CHF
CO2 retention
Are cultures needed in COPD exas?
No, just give antibiotics that are broad coverage, no sputum culture needed
How can you tell COPD exas from PE
PE is more acute onset with more severe hypoxia, they also have LOW CO2 compared to CO2 retention in COPD. They always have metabolic alkalosis
Does fibrosis cause decreased DLCO?
Yes, the fibrosis impairs gas exchange, there is low DLCO is fibrosis and emphysema, but not in COPD or asthma
How does PE reduce preload to LV?
PE causes hypoxic vasoconstriction which increases pulmonary artery pressure and backs up to the weak right side of heart increaing pressure there, less blood gets to LV and there is decreased CO
What are SABA used of antiLKT or ICS in exercise induced asthma?
If they exercise less than every day, or toelrate SABA, it is more effective. If they do daily or cannot tolerate SABA, LKT block or SABA
In fibrosis/interstitial lung disease, what is DLCO like?
DLCO is REDUCED in interstitial lung diseases
Who doens’t need assessment for blood tinged-sputum?
low risk, young, non somking patients that is not recurrent wthout history of lung diseases adn bleeding is not more than 30mL
What does NPPV help in COPD
It is used when other intervention fail and CO2 rises as O2 supp will not reduce CO2 and NPPV decreases work of breathing and improves ventilation allowing lowering fo CO2
Indication for pleural thoracostomy?
Less than 7.2 pH or glucose
what do steroids do to blood counts, IE acute asthma?
Steroids cause lymphopenia of eosinophils and lymphocytes, but marginate neutrophils and increase these with over high Wbc
What arhtymia does mitral stenosis commonly cause
mitral stenosis commonly causes afib in foreign, young adult early adult indivdiauls
what is a common sign of enlarged LA
an enlarged LA such as in mitral stenosis causes elevation of left main stem bronchus and they commonly have afib
What are s/s of OHS
obese patient with daytime HYPERCAPNIA with hypoxemia and often elevated hematocrit ; resulting in a respiratory acidosis
In a new, high chance single respiratory nodule that was not present on previous CXR, what is always the first step?
No nodule not on previous CXR that has malignant features? CT no matter what, never biopsy first. CT CT CT
